title: Perioperative fluids: a clear road ahead?
abstract: OBJECTIVE
  There is significant controversy for perioperative fluid management. This review discusses the evidence from clinical studies, basic research, and systematic reviews to provide a summary of the current best practice in this area.
  
  
  RESULTS
  Recent evidence has challenged the long-held contention that use of colloids results in substantially less fluid volumes to achieve resuscitation endpoints. Meanwhile, evidence that hydroxyethyl starch does carry a risk of renal toxicity is now strong. Mounting evidence also points to a hazard, especially for the kidney, when large volumes of saline are used. A patient's clinical condition may also determine the deposition of infused fluids in the body. Total positive fluid balance is an indicator of adverse clinical outcomes, though a cause-effect relationship has not been firmly established. The optimal perioperative fluid management requires a balance of the beneficial and adverse effects of intravenous fluid.
  
  
  CONCLUSIONS
  Although potentially life-saving, evidence points to significant hazards associated with various types and use-strategies for intravenous fluids. Like other drugs, intravenous fluids should be used with caution for specific indications, in specific amounts, and with careful attention to potential adverse effects associated with various products. An individualized approach to perioperative fluid therapy is recommended.
authors.affiliation: Department of Critical Care Medicine, The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, PA 15261, USA.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Peng
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
mesh_terms: D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods / Q000639:trends; D006801:Humans; D020896:Hypovolemia / Q000188:drug therapy*; D019990:Perioperative Care; D015532:Rehydration Solutions / Q000737:chemistry / Q000627:therapeutic use*; D018570:Risk Assessment
chemical_list: D015532:Rehydration Solutions